Issuu

P U B L I C H E A LT H N E T W O R K C Y M R U

E - BULLETIN SEPTEMBER 2023

ALCOHOL AND SUB STANCE MISUSE

Alcohol and Substance Misuse

September 2023

Welcome W

elcome to September’s e-bulletin. This month the focus is on alcohol and substance misuse.

Substance abuse or misuse is defined as the continued misuse of any psychoactive substance that is harmful or hazardous to a person’s wellbeing health, social situation and responsibilities. Alcohol dependence is the most common form of substance misuse, but any drug comes into this category, as does the misuse of glue and aerosols and prescription medicines. This e-bulletin includes articles which look at national, regional and local initiatives which focus on support available to those in need. Do you have any projects, research or case studies to share with the wider public health community in Wales? Send your articles to Publichealth.network@wales.nhs.uk or @PHNetworkCymru

Alcohol and Substance Misuse

September 2023

In this issue... 4

Articles An occupational perspective of substance use: The meaningful doing of addiction and dependency Jon Fisher, Highly Specialist Occupational Therapist, Aneurin Bevan Specialist Drug and Alcohol Service (ABSDAS)

Cyfle Cymru: Unlocking Opportunities for a Healthy Working Wales Chloe Harrison, Research & Evaluation Office; Marian Williams, Associate Director of Employment & Mentoring; Lisa Thompson, Cyfle Cymru North Wales Project Manager, Adferiad Recovery

National Alcohol Care Team Advisory Group (ACTAG) Andrea Pace, NHS Wales Collaborative

Development of An All Wales Alcohol Care Patient Information Leaflet

David Samuel, Clinical lead for Hepatology; Densire Lowry, Head of Value Based Health Care; Marie Evans, Head of Planning and Commissioning; Leanne Baylis, Strategic Planning and Commissioning Manager - Cwm Taf Morgannwg University Health Board

Together we can bridge the gap to recap the bottle

The Grapevine High quality provision is essential if free school meals and free childcare are to improve our children’s health Building a Healthier Wales Coordination group

Videos

News & Resources

Topics

Next Issue

Alcohol and Substance Misuse

September 2023

Articles

Practice

An occupational perspective of substance use: The meaningful doing of addiction and dependency Jon Fisher, Highly Specialist Occupational Therapist, Aneurin Bevan Specialist Drug and Alcohol Service (ABSDAS)

ccupational Therapists are registered health and social care professionals. Occupational Therapists focus on working collaboratively with individuals to ensure they can live purposeful and satisfying lives by doing all the things they want to or need to do (1). They are duel trained in physical and mental health interventions, making them ideally suited to provide holistic care and treatment within increasingly complex healthcare landscapes. The role of Occupational Therapy is well established throughout mental health services in Wales (2), with their intervention shown to reduce the demand on GP services by increasing individuals’ confidence to manage their physical health conditions (3); reduce the length of admissions by up to 20% within inpatient mental health wards and support those with enduring mental health conditions back into employment (4).

Aneurin Bevan Specialist Drug and Alcohol Service (ABSDAS) provides specialist assessment and intervention to adults experiencing cooccurring complexities (physical, mental health, pregnancy, alcohol related brain damage) alongside their substance use. In 2022, ABSDAS sought the addition of Occupational Therapy to their multidisciplinary team. A recent scoping review found the inclusion of Occupational Therapy in substance use settings has been beneficial, with interventions that prioritise the development of life skills and re-engagement in meaningful roles and routines (5).

Occupational Therapy in ABSDAS has advocated for the ‘occupational perspective’ of substances use and how this understanding can be harnessed to promote an individual’s successful journey throughout recovery (6). Understanding the nuances of someone’s substance use, and how this has shaped their occupational identity, organised their routine and lifestyle, offered a connection and sense of belonging with others and a means to exert control over one’s life, we can begin to collaborate more effectively on the incremental steps involved in the interventions of recovery. In doing so, it may also promote treatment retention (6).

Alcohol and Substance Misuse

September 2023

Occupational Therapists can ‘apply their expertise and knowledge of daily occupations, time management skills and positive coping strategies to support restoration of healthy habits and routines in the recovery process’ (7). Occupational Therapists can bring their understanding to what underlies someone appearing to be ‘not motivated’ or ‘bored’ as part of their treatment. Often there are unrecognised ‘occupational needs’ that might hinder someone’s progress towards their treatment related goals (see Image 1.). A recent systematic review of alcohol use disorder relapse factors found that a higher sense of ‘self-efficacy’ along with a perceived sense of ‘purpose’ and meaning in life were considered significant protective factors against relapse (8). These can only be achieved through successful participation in life roles, providing those essential opportunities for re-establishing a balanced lifestyle during recovery. Occupational Therapists may enhance current treatment approaches, applying their core skill set to support individuals to recognise and overcome the many barriers to progress in recovery. Occupational Therapists support this through applying their core skills of analysing activity, applying the principles of grading and pacing, use of specific occupation for therapeutic effect, detailed understanding of time-use and cognitivebased skills, using occupations as intervention media as well as the outcome, modifying occupations for successful participation and adapting the physical and social environments (9). The outcome is meaningful participation in occupation, reflecting sustainable recovery from addiction and dependency. References 1 Royal College of Occupational Therapists (2019). What Is Occupational Therapy? OT Explained - RCOT. [online] Rcot. co.uk. 2 Royal College of Occupational Therapist, (2017). Adult Mental Health.pdf - RCOT 3 Bevan Commission. (2021). Evaluating the Value and Impact of Occupational Therapy in Primary Care. [Accessed 7 Apr. 2022]. 4 Getting my life back: Occupational therapy promoting mental health and wellbeing in Wales. (n.d.). [online] 5 Ryan, D.A. and Boland, P. (2021). A scoping review of occupational therapy interventions in the treatment of people with substance use disorders. Irish Journal of Occupational Therapy, 49(2), pp.104–114. 6 Wasmuth, S., Crabtree, J.L. and Scott, P.J. (2014). Exploring Addiction-as-Occupation. British Journal of Occupational Therapy, [online] 77(12), pp.605–613. 7 Jarrard, P., Cunningham, S., Granda, P., Harker, P., Lannan, T. and Price, K. (2021). Who Are You Without Your Substance? Transforming Occupational Time Use in Recovery. Modern Applied Science, 15(6), p.19. doi:10.5539/mas. v15n6 p19 8 Sliedrecht, W., de Waart, R., Witkiewitz, K. and Roozen, H.G. (2019). Alcohol use disorder relapse factors: A systematic review. Psychiatry Research, 278, pp.97–115. doi:10.1016/j.psychres.2019.05.038. 9 RCOT (2016) Entry level Occupational Therapy core knowledge and practice skills. [online] Entry-level-core-OT.pdf (rcot.co.uk) To find out more details, please visit It is the difference between living or existing - Barod Jonathan.fisher2@wales.nhs.uk @Fisheraddiction

Alcohol and Substance Misuse

September 2023 Practice

yfle Cymru is a service operating across five areas of Wales that helps people affected by substance misuse and/or mental health conditions into work, education, or training. For many individuals struggling with poor mental health or addiction, accessing opportunities for personal and professional growth can often feel unattainable;

We asked David, one of our peer mentors why he got involved with Cyfle Cymru. He said; “I wanted to give back to the community and support people who were in a similar position that I had been in, and show them that things can and do change.” - David For those looking to enter or re-enter the workforce, our service offers invaluable work experience opportunities. In addition, it recognises the significance of giving back to the community through volunteering, helping individuals gain a sense of purpose and fulfilment.

“After I had my emotional and mental collapse, I felt incredibly isolated and alone, without any hope for the future or even wanting to exist for that matter” – Client

This incredible service is delivered through a partnership between three Welsh charities: Adferiad Recovery, Barod, and Kaleidoscope. It was renewed in late 2022, after the service had previously been operating for six years. However, with some excellent work in developing new proposals and evidencing need, Adferiad was successful in tendering for five of the seven lots in the new Welsh Government funded ‘Out of Work’ Service, replacing the EU funded programme which ceased post Brexit. We are proud to say that Cyfle Cymru now runs across North Wales, Dyfed, Swansea Bay, Powys, Cardiff and the Vale of Glamorgan.

However, Cyfle Cymru not only provides support, but also helps people to gain confidence, opening doors to training, qualifications, work experience, and volunteering that may have before seemed impossible to reach; “I’m so appreciative as I needed someone to be invested in helping me instead of nodding their head while taking notes. Lois took a genuine interest and that was exactly what I needed.” Client What makes this service so special is that it is led by a dedicated team of peer mentors, who, by drawing upon their own lived experience of addiction and mental health, can empower people to overcome their substance misuse and mental health challenges and unlock their full potential.

Alcohol and Substance Misuse

September 2023

In just the first six months after relaunching, Cyfle Cymru made significant strides in its mission to empower individuals facing challenges related to mental health and substance misuse. Between October 2022 and March 2023, the service received over 1,400 referrals, 31% of whom had cooccurring mental health and substance misuse problems. During this time, 152 clients completed volunteering, 29 entered full-time education or training, and a further 21 entered employment – a brilliant result! For those facing stigma due to mental illness or addiction, Cyfle Cymru provides a beacon of hope. It shows the possibility of overcoming adversity and achieving personal and professional goals, even when the journey may seem impossible. If you would like more information about Cyfle Cymru, visit our website: https://adferiad.org/ services/cyfle-cymru/ or email ask@cyflecymru.com Practice

National Alcohol Care Team Advisory Group (ACTAG) Andrea Pace, NHS Wales Collaborative

he National Alcohol Care Team Advisory Group (ACTAG) came about from the first Strategic National Alcohol Care Team workshop in 2019. The workshop shared best practice and raised the profile of Alcohol Care Teams and the work they do across Wales. During 2020 some specialist nurses came together to share best practice and support one another and during these meetings it was identified there was a need to have a National Alcohol Care group for all seven health boards across Wales and stakeholders, with the aim of exploring challenges faced and sharing best practice.

Recently the group identified more referrals of patients that also have eating disorders across Wales. The group have appointed a lead on the project to research and feedback to the group. Project successfully delivered: The group has started the work of coordinating activities within the Alcohol Care Teams and support service in all Welsh hospitals. We are developing a once for Wales approach to service provision: • Reduce variation in both provision and outcomes for patients with alcohol related diseases • Improved communications between health boards with mutual support • Education materials have been shared across services • Welsh Nurse Care Record (WCNR) when delivered will significantly increase the profile of alcohol misuse disorders in Welsh hospitals to deliver better outcomes.

The ACTAG membership includes multiple professionals and provides strategic direction for alcohol support services in all Welsh hospitals, works to a level to drive up standards, reduce variation and support one another in terms of education and provision of best practice. The ACTAG are currently working on: Inclusion of the AUCIT-C questionnaire on Welsh Nurse Care Record (WNCR) platform: It is an excellent platform for collecting information and it is a great opportunity to engage the patient group as a means of identifying alcohol misuse disorders. It was identified that there is a need for a development of an All Wales Educational Training Materials for new NHS health boards staff, we aim to work towards the training to be mandatory. 7

Alcohol and Substance Misuse

September 2023

The collaborative working has made a difference to its members, stakeholders, Health Boards and patients. This has happened through the group by: • Improved communications between Health Boards and services • Allowing everyone to work cohesively as a group • Avoiding duplication • Sharing ideas and lessons learnt • Supporting each other’s development if needed • Allow an easier transition for new members of the team • Improved communication with patients that sit on the border of health board boundaries. Key learning points: • To have a coordinated strategic approach to alcohol misuse management across the Welsh NHS and to continue to work with other key stakeholders • Importance of collaborative working, sharing of best practice which also avoids duplication of work. Everyone’s input welcomed and valued • Ensure a patient centred value based healthcare approach and co-production model where services are at the centre of improving alcohol care • Coproduction with service users and partners is critical • At each meeting there are actions that are allocated to members. The person is responsible for action and feedback at the next meeting. These actions build to create positive change that affect the outcome or perception of patients within the hospitals. For further Information please contact: Andrea.pace3@wales.nhs.uk or visit Liver Diseases - NHS Wales Executive

Alcohol and Substance Misuse

September 2023 Practice

Development of An All Wales Alcohol Care Patient Information Leaflet David Samuel, Clinical lead for Hepatology; Densire Lowry, Head of Value Based Health Care; Marie Evans, Head of Planning and Commissioning; Leanne Baylis, Strategic Planning and Commissioning Manager - Cwm Taf Morgannwg University Health Board

he National Alcohol Care Team Advisory Group, whom consists of multiple professionals (Consultants in Mental Health & Medicine, Alcohol Liaison & Substance Misuse nurses and practitioners, Value Based Health Care, Strategic Planners, Public Health Wales specialists) meet on a quarterly basis to share learning and good practice across Wales.

accessing alcohol services • Raise awareness of the local Alcohol Care Team (ACT) services across Wales • Ensure a patient centred value based healthcare approach and co-production model where services were at the centre of improving alcohol care services • Increase referrals and support • Encourage a behaviour change and reduce alcohol consumption • Design a leaflet that can be used for all Health Boards within Wales with opportunity to include localised information / contact details

The group identified a lack of consistent patient / service user information for Hospital based Alcohol Care Services across Wales. A project was agreed to develop an Alcohol Care Team Service user information leaflet that would be fit for purpose and to be utilised across all the Welsh Health Boards providing equity and consistency. A plan was put in place to ensure a patient centred approach with service users being co-authors both on design and content of the leaflet. Stage one of this work commenced with a workshop, which was led and facilitated by Cwm Taf Morgannwg University Health Board’s Value Based Healthcare Team & Strategic Planning Team, ensuring a collaborative and multi-professional partnership working approach. Representatives were invited from all 7 health boards in Wales. The purpose of this workshop was to facilitate the national approach, develop the technical content and proposed design for a patient information leaflet with a view to sharing the draft and engaging with a service user group for their comment, advice and further guidance. The aim of the project was to: • Reduce the stigma when 9

Alcohol and Substance Misuse

September 2023

Expert advice from Communication and Engagement teams within the Health Board was an integral part of the workshop. The COM-B model was used in the context of developing the patient leaflet, to identify what needed to change in order for a behaviour change intervention to be effective. It identifies three factors that need to be present for any behaviour to occur: capability, opportunity and motivation. Stage two of this project i.e. service user involvement, made a significant difference within this project as the initial draft leaflet produced by professionals working within alcohol care services was changed significantly following their review and input. In summary, the service users had a different view on both the draft narrative and design that was proposed to them. The co-production and patient centred approach ensured the design and key messages within the leaflet were: • Easily understood using appropriate language and terminology • The design and narrative aimed to reduce stigma in accessing services • The images used reflected the diversity of people who may need support in relation to their alcohol consumption. The leaflet notes the service user involvement group as key authors in the development of the leaflet. This project proved to be an excellent example of shared decision making and co-production between professionals and service users. Key learning points: • Professional and service user views can be very different • Involve all key stakeholders including service users from the outset and ensure continual engagement to the end product and beyond • Coproduction with service users and partners is critical • Implementing a Patient Centred Value Based Health Care Approach • Include consistent messaging and brand. For further Information please contact: David Samuel, David.Samuel@wales.nhs.uk Denise Lowry, Denise.Lowry@wales.nhs.uk Marie Evans, Marie.Evans2@wales.nhs.uk Leanne Baylis, Leanne.Baylis@wales.nhs.uk

Alcohol and Substance Misuse

September 2023 Practice

Together we can bridge the gap to recap the bottle David Samuel, Clinical lead for Hepatology; Densire Lowry, Head of Value Based Health Care; Marie Evans, Head of Planning and Commissioning; Leanne Baylis, Strategic Planning and Commissioning Manager - Cwm Taf Morgannwg University Health Board

he aim of this project was to work in partnership with patients, healthcare professionals, Area Planning Boards and the third sector to develop a person-centred alcohol care approach across the Cwm Taf Morgannwg landscape.

From the outset the ambition was to ensure a patient-centred approach and service for patients with alcohol related problems, in ways and places which meet the needs of the patients and families accessing them, in partnership with patients, families and other partners. We initially mapped our presumed stakeholders first and then with the assistance of the third sector i.e. Barod, held sessions with service users to ask them, who to involve, how to involve and their honest feedback of their experiences, needs and aspirations.

The project focuses on enhancing, improving and expanding our alcohol care services from a 5 to 7 day provision, which was funded following a successful bid to the national Value Based Health Care Programme. The project is based on ValueBased Healthcare principles and focused on a life-course and whole system approach which starts from the user being able to share their experiences, their needs and aspirations in a way that meets their needs and informs the review, planning and implementation of new models of care and feedback.

We provided a safe, supported and nonjudgemental space and a range of opportunities to provide their feedback, mindful of stigma and confidentially. We shared our ideas and they shared theirs. During these sessions we involved a creative song-writer to work with us all to capture their voices in a powerful way. A “spoken word” song has been produced which captures patient stories and their aspirations for the future. This song was played live to a varied audience of multi -agency service providers and service users at a celebration event, as part of a series of events we held for Alcohol Awareness Week in July 2023. Each service user was presented with a signed framed gift of the lyrics of their song along with other useful gifts which included a tote bag with the caption “you are valued”. This song is an innovative and heart-felt way of sharing and increasing awareness of the service user experience.

Initially clinical teams and partners undertook a mapping exercise and research which highlighted that the service was provided in restricted hours i.e. 9 – 5 Monday-Friday, which meant we were not meeting needs in the hours most likely for alcohol related hospital admissions. Questions about alcohol were not routinely asked or onward referrals made in over 70% of emergency and planned admissions leading to unplanned detox, and missed opportunities to support, which led to continued re-admissions, known as frequent flyers and a system which was not providing the support required by our population. There was also limited capacity within the service with the equivalent of one whole time equivalent Alcohol Liaision/Substance Misuse on each District General Hospital site. Evidence demonstrated that alcohol use patterns had changed and worsened through and post COVID for all ages therefore there was significant unmet need as well as increasing demand on the existing services.

Alcohol and Substance Misuse

September 2023

The service users have also undertaken specific pieces of work to assist us in shaping our service such as the development of a patient leaflet to use on an all Wales basis, a questionnaire to determine if support is needed for patients visiting emergency departments and a service user will be present at the interviews for the new staff to be employed within the 7 day service, and their involvement is represented on the patient leaflets. Person Centred Care has to start with the person receiving it, with those delivering it in partnership. People’s voices must be gathered in whichever way suits them, but we must listen. This service is being built with them, to ensure we do have data for the future, but more than that, we know what works and what is valued by the people receiving the care. This has been a true collaboration with openness and involvement from a wide range of stakeholders. It is important to note not everything costs money, patients are keen to get involved and help if you ask and support them in the right way. This article is about them and is for them. For further Information please contact: Denise.Lowry@Wales.nhs.uk Marie.Evans2@Wales.nhs.uk

Alcohol and Substance Misuse

September 2023

The Grapevine

Policy

High quality provision is essential if free school meals and free childcare are to improve our children’s health Building a Healthier Wales Coordination group

Roll-out of free school meals and childcare must not compromise on quality if we are to safeguard the health of those most disadvantaged. This is the message from senior leaders in the Building a Healthier Wales Coordination group.

The findings, produced at the request of the Minister for Health and Social Services, will be important for local authorities as they continue to implement Welsh Government policies. It is vital that the implementation of policies such as the extension of early year’s childcare and The group, established in 2019, aims to the provision of free school meals to all primary maximise the impact of the collective agencies pupils does not widen, and ideally narrows, that make up its membership, in order to improve existing inequalities. health and well-being and reduce inequalities. In their report, they recommend actions to The Building a Healthier Wales Co-ordination support implementation – such as: Group is a non-statutory coalition of strategic • Ensuring that uptake of free school meals leaders representing organisations and strategic is high and provision is inclusive perspectives from public, private and third • Providing opportunities to play and sectors with a diversity of representation across socialise within the setting Wales. Members include representatives from • Learning from other out-of-school food Local Government, Health Boards, Public Health provision programmes Wales, Welsh Local Government Association, • Developing sustainable provision which Natural Resources Wales, Welsh Government, supports local foundational economies Social Care Wales, Sport Wales, the police, the over the long term CBI, housing and voluntary sector. • Embedding fair working practices in school catering Further information is available here.

Alcohol and Substance Misuse

September 2023

Videos Getting to the root of the problem – A Whole System Approach to Healthy Weight in Wales Join colleagues from Public Health Wales who provided an overview of what is meant by the term Whole Systems Approaches and how it is being used to support healthy weight in Wales. The webinar described the evidence, strategic context and the nine step approach to whole systems approaches in Wales. The webinar discussed why working in this way is different from more traditional partnership working.

Watch

Tackling the public health effects of climate change – find out how you and your team can take action This webinar introduced a free online resource that helps individuals and teams to take action to reduce their environmental impact.

Watch The role of design in public health This webinar is an introduction to the Design Council who holds more than 20 years’ experience developing frameworks that support organisations to embed design practice and new ways of working.

Watch View all our videos

Explore our video library on our website

Alcohol and Substance Misuse

September 2023

News & Resources

Health Impact Assessment for Climate Adaptation

Climate Action Wales – new website

03-10-2023

New research shows public support for our paths

28-09-2023

26-09-2023

All News Welsh Institute of Physical Activity, Health and Sport: Annual Report 2022 Welsh Institute of Physical Activity, Health and Sport

Nicotine and tobacco-free schools: policy development and implementation toolkit World Health Organization

All Resources 15

Alcohol and Substance Misuse

September 2023

Topics

Mental Wellbeing Stress and resilience Arts and health Spirituality

Prevention and Improvement in Health and Healthcare

Wider determinants of health

Nursing Now Cymru/Wales Mental Ill Health

Poverty

Mental Health Conditions Suicide and self-harm prevention

Income and debt Benefits

Non-communicable Diseases

Housing

Diabetes

Homelessness Fuel poverty Housing quality

Communicable disease

Foodborne Communicable Diseases Influenza (Flu) Sexually Transmitted Infections Coronavirus (COVID-19)

Education and Training

Preschool School Further, higher and tertiary education

People LGBT+ Gender Learning, physical and sensory disabilities Maternal and newborn health Offenders Older adults Ethnicity Carers Working age adults Children and young people Early years Adverse Childhood Experiences (ACEs)

Community

Assets Based Approaches Social capital

Environment

Climate change Natural enviroment Sustainable development Built environment

Employment

Unemployment Precarious work Good, fair work

Health in all policies Building a Healthier Wales Health Inequalities Social justice and human rights Wellbeing of future generations

Health related behaviours Psychoactive substances Alcohol

Food and Nutrition Healthy Weight Accident and Injury Prevention Smoking and vaping Physical Activity Oral Health Sexual health

Approaches and methods in public health practice

Communities4Change Wales Systems thinking in public health Evaluation Behavioural Science

All Topics 16

Alcohol and Substance Misuse

September 2023

Next Issue SYSTEMS THINKING IN PUB LIC HEALTH Systems thinking helps us develop and evaluate policies and initiatives by considering relationships, interactions, boundaries and perspectives. To influence some of the big public health challenges of our modern societies means going beyond a linear approach. Although there is no universal definition of a system it can generally be regarded as a group of interacting, interrelated and interdependent components that form a complex and unified whole (The Systems Thinker, 2018).

For our next e-bulletin we would welcome articles which cover national, regional or local initiatives which demonstrate how organisations are using systems thinking to influence the future health and wellbeing of the people of Wales.

Contribute